Anal Cancer

Anal cancer expertise at Scripps Health

Scripps Health offers options for the treatment of anal cancer.

Anal cancer expertise at Scripps Health

Scripps Health offers you access to a very select group of San Diego physicians who are specially trained and experienced in the treatment of anal cancer.

This rare form of colorectal disease requires care from highly skilled doctors who have managed complex anal cancer cases — the best doctors who have earned board certification in the surgical sub-specialty of colon and rectal surgery.

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Fighting cancer is what we do

Scripps offers more ways to fight cancer than any local health care provider. Our accomplished gastrointestinal specialists, medical oncologists, pathologists, board-certified colon and rectal surgeons, radiation oncologists, nurses and clinicians stand ready for you.

Anal cancer detection and diagnosis

While anal cancer behaves and is treated much differently than either colon or rectal cancer, the process for screening is essentially the same. Starting at age 50, it is recommended by physicians and national cancer organizations that you get screened for colorectal and anal cancers. A colonoscopy is considered the “gold standard” for screening. It is the most effective approach for finding early signs of cancers of the colon, rectum or anus.

Other screening tests and procedures for anal cancer can include:

  • Digital rectal exam (DRE) is an exam in which a physician inserts a gloved finger into the anus and rectum to feel for abnormalities such as polyps or lesions.
  • Anoscopy is an exam of the anus and lower rectum in which the physician uses a lighted tube called an anoscope.
  • Proctoscopy is an exam of the rectum in which the physician uses a lighted tube called a proctoscope.
  • Endorectal ultrasound (ERUS) uses an instrument that is inserted into the anus and rectum with a probe at its end that emits ultrasound (high-energy) waves off organs to create an image known as a sonogram.
  • Physical exam and history, which includes a discussion with your physician about health habits and past medical treatments.

In addition to anal cancer screening, Scripps physicians may use other tests and procedures to detect, diagnose and stage the disease, including biopsy, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or positron emission tomography (PET) scan.

Anal cancer treatment

The most common type of anal cancer is squamous cell carcinoma (originating from squamous cells lining the anal canal and perianal skin).

Treatment for anal cancer most often consists of a combination of radiation therapy and chemotherapy — with surgery used only when initial treatment fails. Individualized treatment plans are based on the cancer’s stage, proximity to sensitive tissues and other organs, patient health and whether the cancer is new or returning.

Treatment options include:

  • Radiation therapy is combined with chemotherapy to fight squamous cell carcinoma of the anal canal. If the cancer does not respond to the combined therapies, an abdominoperineal resection (see below) may be the next recommended course of treatment. Radiation therapy alone or in combination with chemotherapy can also be used before and after a local excision surgery. Scripps Radiation Therapy Center offers leading-edge intestinal cancer treatment, backed by San Diego’s best doctors.
  • Chemotherapy for anal cancer can be combined with radiation therapy before and after local excision surgeries for squamous cell carcinoma anal cancers. It may also be used alone or in combination with radiation therapy for recurrent anal cancers or to provide palliative care for patients with cancers that have spread to other parts of the body.

Surgery for anal cancer

There are the two most common anal cancer surgeries:

  • Abdominoperineal resection (APR) is an extensive surgery with removal of the anus, rectum and distal colon along with the removal of nearby lymph nodes. The abdominal portion of this procedure is performed with either a minimally invasive laparoscopic approach or a minimally invasive robotic approach. An APR requires a colostomy for the patient to pass fecal waste following surgery as the anus is completely removed.
  • Local excision (also called “resection”) is usually performed for the removal of squamous cell cancers of the perianal skin. This is treated similar to a squamous cell skin cancer that may be found anywhere else on the body. With a wide local excision, surgeons seek to preserve the patient’s sphincter muscles so normal bodily functions can be maintained.

Support services

To enhance the care of people with anal cancer, Scripps Health also offers the following services: